How to Select the Right ICD-10 Code in Three Easy Steps

Earlier this month, we showed you how to find the correct ICD-10 equivalent of an ICD-9 code; discussed tips for coding pain and injuries; and provided you with a list of common therapy-specific codes. Now, let’s talk about how to navigate the alphanumeric coding labyrinth known as ICD-10 from patient diagnosis to final code submission. With more than 68,000 codes to wade through, identifying the correct (read: most specific) one might seem a bit like finding a needle in a haystack. And while there are definitely instances in which the code selection process could get a bit gnarly, most of the time you should be able to arrive at the right code in these three basic steps, as adapted from this article:

1. Look up the patient condition in the alphabetic index of the full tabular list.

The index is contained within the file labeled “ICD-10-CM 2014 Addenda.” If you can’t find the condition you’re looking for, try opening the full tabular list and using your PDF viewer’s search function to find codes related to the condition.

2. Find the appropriate code within the full tabular list.

You might initially land on a general, “unspecified” version of the code, so make sure you check to see if more specific levels of the code exist. For example, let’s say the first code you identify for a particular scenario is M66.30 (Spontaneous rupture of flexor tendons, unspecified site). Although the code is technically correct, it’s not the most specific code available. And if you look at the codes listed below it, you will see that there are many additional—and more specific—coding options for this condition, as shown below.

Before making your final selection, you’ll also want to check the tabular list for any additional notes or instructions that apply to a particular section or category of codes. For example, the codes shown above fall into the category M66 (Spontaneous rupture of synovium and tendon). At the beginning of the category, you will find the following notes:

“Includes” notes serve to further define or exemplify a category. As for “Excludes” notes, there are two different types: 1 and 2. According to these ICD-10 guidelines, “Excludes1” notes represent true exclusions: “An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.” Conversely, “Excludes2” notes—like the ones shown above—indicate “that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.”

3. Check the guidelines at the beginning of the chapter.

In addition to the notes inserted within particular sections or categories of codes, there also are notes included at the beginning of each chapter of the tabular list. For example, at the very beginning of chapter 13—the musculoskeletal or “M” code chapter—you will see several notes, including the one shown below. (As a side note, we’ll take an in-depth look at external cause codes in tomorrow’s blog post.)

You should also review the chapter-specific guidelines found in this document.

Have you tried coding a particular diagnosis using the new code set? What questions or advice do you have? Share your thoughts in the comments section below.